{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T01:28:56Z","timestamp":1793755736533,"version":"4.6.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000925","name":"Department of Health | National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1196261"],"award-info":[{"award-number":["1196261"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Prince of Wales Hospital Foundation, Randwick, Australia.","id":[{"id":"https:\/\/ror.org\/01491q767","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spinal Cord"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Sub-analysis of a randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Respiratory muscle training (RMT) in people with tetraplegia yields marked improvements in inspiratory muscle strength. The present study investigated whether RMT also modifies sleep disordered breathing (SDB) and daytime sleepiness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Independent research institute in Sydney, Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty-two adults with tetraplegia underwent six weeks of supervised RMT. The active-RMT group trained the respiratory muscles through progressive threshold loading to a mean intensity of 50% maximal inspiratory pressure whereas the sham-RMT group experienced the same training protocol, but their device had no progressive threshold load. Primary measures of SDB were obtained using level II ambulatory polysomnograms and daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS) at baseline and after 6-weeks RMT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-eight participants completed two home-based polysomnograms. Maximal inspiratory pressure (primary outcome) increased more after active intervention than sham, between-group difference 11.8cmH\n                      <jats:sub>2<\/jats:sub>\n                      O (95%CI, 5.2\u201318.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001). There were no between group differences for any SDB parameter; mean apnoea-hypopnea index (\u00b1\u2009SD) (active 46\u2009\u00b1\u200921 vs. 45\u2009\u00b1\u200922 events\/h; sham 44\u2009\u00b1\u200925 vs. 40\u2009\u00b1\u200925 events\/h;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.553) nor ESS (active 9.5\u2009\u00b1\u20095.7 vs. 9.2\u2009\u00b1\u20096.7; sham 10.8\u2009\u00b1\u20096.2 vs. 10.1\u2009\u00b1\u20095.8;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.952).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite significant increases in inspiratory muscle strength, 6 weeks of supervised respiratory muscle training at a mean intensity of 50% maximal inspiratory pressure does not reduce SDB or daytime sleepiness in people with tetraplegia and severe SDB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41393-026-01252-8","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:02:30Z","timestamp":1786644150000},"page":"1047-1054","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of respiratory muscle training on sleep disordered breathing in people with tetraplegia: a sub-analysis of a randomised controlled trial"],"prefix":"10.1038","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4922-5262","authenticated-orcid":false,"given":"Claire L.","family":"Boswell-Ruys","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. H. Chaminda","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel A.","family":"McBain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirupama S.","family":"Wijesuriya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3503-2363","authenticated-orcid":false,"given":"Danny J.","family":"Eckert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonsan Bonne","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon C.","family":"Gandevia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E.","family":"Butler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"1252_CR1","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.resp.2009.08.014","volume":"169","author":"F Biering-Sorensen","year":"2009","unstructured":"Biering-Sorensen F, Jennum P, Laub M. Sleep disordered breathing following spinal cord injury. Respir Physiol Neurobiol. 2009;169:165\u201370.","journal-title":"Respir Physiol Neurobiol"},{"key":"1252_CR2","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1016\/j.apmr.2004.11.033","volume":"86","author":"DJ Berlowitz","year":"2005","unstructured":"Berlowitz DJ, Brown DJ, Campbell DA, Pierce RJ. A longitudinal evaluation of sleep and breathing in the first year after cervical spinal cord injury. Arch Phys Med Rehabil. 2005;86:1193\u20139.","journal-title":"Arch Phys Med Rehabil"},{"key":"1252_CR3","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1038\/s41393-020-00595-0","volume":"59","author":"M Graco","year":"2021","unstructured":"Graco M, McDonald L, Green S, Jackson M, Berlowitz D. Prevalence of sleep-disordered breathing in people with tetraplegia - a systematic review and meta-analysis. Spinal Cord. 2021;59:474\u201384.","journal-title":"Spinal Cord"},{"key":"1252_CR4","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1016\/S0140-6736(05)71141-7","volume":"365","author":"JM Marin","year":"2005","unstructured":"Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046\u201353.","journal-title":"Lancet"},{"key":"1252_CR5","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1097\/PHM.0b013e3181d896b9","volume":"89","author":"S Rajan","year":"2010","unstructured":"Rajan S, McNeely MJ, Hammond M, Goldstein B, Weaver F. Association between obesity and diabetes mellitus in veterans with spinal cord injuries and disorders. Am J Phys Med Rehabil. 2010;89:353\u201361.","journal-title":"Am J Phys Med Rehabil"},{"key":"1252_CR6","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1038\/sc.2012.55","volume":"50","author":"JW Middleton","year":"2012","unstructured":"Middleton JW, Dayton A, Walsh J, Rutkowski SB, Leong G, Duong S. Life expectancy after spinal cord injury: a 50-year study. Spinal Cord. 2012;50:803\u201311.","journal-title":"Spinal Cord"},{"key":"1252_CR7","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1016\/j.apmr.2021.08.015","volume":"103","author":"GS Panza","year":"2022","unstructured":"Panza GS, Sutor T, Gee CM, Graco M, McCully KK, Chiodo A, et al. Is sleep disordered breathing confounding rehabilitation outcomes in spinal cord injury research? Arch Phys Med Rehabil. 2022;103:1034\u201345.","journal-title":"Arch Phys Med Rehabil"},{"key":"1252_CR8","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.apmr.2023.08.006","volume":"105","author":"W Ji","year":"2024","unstructured":"Ji W, Nightingale TE, Zhao F, Fritz NE, Phillips AA, Sisto SA, et al. The clinical relevance of autonomic dysfunction, cerebral hemodynamics, and sleep interactions in individuals living with SCI. Arch Phys Med Rehabil. 2024;105:166\u201376.","journal-title":"Arch Phys Med Rehabil"},{"key":"1252_CR9","doi-asserted-by":"publisher","first-page":"695","DOI":"10.5664\/jcsm.5798","volume":"12","author":"DJ Fogelberg","year":"2016","unstructured":"Fogelberg DJ, Hughes AJ, Vitiello MV, Hoffman JM, Amtmann D. Comparison of sleep problems in individuals with spinal cord injury and multiple sclerosis. J Clin Sleep Med. 2016;12:695\u2013701.","journal-title":"J Clin Sleep Med"},{"key":"1252_CR10","doi-asserted-by":"publisher","first-page":"2853","DOI":"10.1113\/JP275222","volume":"596","author":"NS Wijesuriya","year":"2018","unstructured":"Wijesuriya NS, Gainche L, Jordan AS, Berlowitz DJ, LeGuen M, Rochford PD, et al. Genioglossus reflex responses to negative upper airway pressure are altered in people with tetraplegia and obstructive sleep apnoea. J Physiol. 2018;596:2853\u201364.","journal-title":"J Physiol"},{"key":"1252_CR11","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1164\/rccm.201303-0448OC","volume":"188","author":"DJ Eckert","year":"2013","unstructured":"Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea. identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188:996\u20131004.","journal-title":"Am J Respir Crit Care Med"},{"key":"1252_CR12","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1152\/japplphysiol.00139.2014","volume":"116","author":"A Sankari","year":"2014","unstructured":"Sankari A, Bascom AT, Badr MS. Upper airway mechanics in chronic spinal cord injury during sleep. J Appl Physiol. 2014;116:1390\u20135.","journal-title":"J Appl Physiol"},{"key":"1252_CR13","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1111\/j.1440-1843.2011.02093.x","volume":"17","author":"S Isono","year":"2012","unstructured":"Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology. 2012;17:32\u201342.","journal-title":"Respirology"},{"key":"1252_CR14","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.5664\/jcsm.6272","volume":"12","author":"L Gainche","year":"2016","unstructured":"Gainche L, Berlowitz DJ, LeGuen M, Ruehland WR, O\u2019Donoghue FJ, Trinder J, et al. Nasal resistance is elevated in people with tetraplegia and is reduced by topical sympathomimetic administration. J Clin Sleep Med. 2016;12:1487\u201392.","journal-title":"J Clin Sleep Med"},{"key":"1252_CR15","doi-asserted-by":"publisher","first-page":"1571","DOI":"10.1172\/JCI115751","volume":"89","author":"WS Mezzanotte","year":"1992","unstructured":"Mezzanotte WS, Tangel DJ, White DP. Waking genioglossal electromyogram in sleep apnea patients versus normal controls (a neuromuscular compensatory mechanism). J Clin Invest. 1992;89:1571\u20139.","journal-title":"J Clin Invest"},{"key":"1252_CR16","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1152\/jappl.2000.88.5.1831","volume":"88","author":"C Worsnop","year":"2000","unstructured":"Worsnop C, Kay A, Kim Y, Trinder J, Pierce R. Effect of age on sleep onset-related changes in respiratory pump and upper airway muscle function. J Appl Physiol. 2000;88:1831\u20139.","journal-title":"J Appl Physiol"},{"key":"1252_CR17","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1113\/jphysiol.2005.083659","volume":"564","author":"RB Fogel","year":"2005","unstructured":"Fogel RB, Trinder J, White DP, Malhotra A, Raneri J, Schory K, et al. The effect of sleep onset on upper airway muscle activity in patients with sleep apnoea versus controls. J Physiol. 2005;564:549\u201362.","journal-title":"J Physiol"},{"key":"1252_CR18","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1113\/jphysiol.1991.sp018537","volume":"436","author":"RL Horner","year":"1991","unstructured":"Horner RL, Innes JA, Holden HB, Guz A. Afferent pathway(s) for pharyngeal dilator reflex to negative pressure in man: a study using upper airway anaesthesia. J Physiol. 1991;436:31\u201344.","journal-title":"J Physiol"},{"key":"1252_CR19","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1038\/sc.2009.56","volume":"47","author":"DJ Berlowitz","year":"2009","unstructured":"Berlowitz DJ, Spong J, Pierce RJ, Ross J, Barnes M, Brown DJ. The feasibility of using auto-titrating continuous positive airway pressure to treat obstructive sleep apnoea after acute tetraplegia. Spinal Cord. 2009;47:868\u201373.","journal-title":"Spinal Cord"},{"key":"1252_CR20","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1016\/j.hrtlng.2020.07.014","volume":"49","author":"N Erturk","year":"2020","unstructured":"Erturk N, Calik-Kutukcu E, Arikan H, Savci S, Inal-Ince D, Caliskan H, et al. The effectiveness of oropharyngeal exercises compared to inspiratory muscle training in obstructive sleep apnea: a randomized controlled trial. Heart Lung. 2020;49:940\u20138.","journal-title":"Heart Lung"},{"key":"1252_CR21","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s11325-019-01862-y","volume":"24","author":"HC Lin","year":"2020","unstructured":"Lin HC, Chiang LL, Ong JH, Tsai KL, Hung CH, Lin CY. The effects of threshold inspiratory muscle training in patients with obstructive sleep apnea: a randomized experimental study. Sleep Breath. 2020;24:201\u20139.","journal-title":"Sleep Breath"},{"key":"1252_CR22","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1007\/s11325-017-1582-6","volume":"22","author":"SD Herkenrath","year":"2018","unstructured":"Herkenrath SD, Treml M, Priegnitz C, Galetke W, Randerath WJ. Effects of respiratory muscle training (RMT) in patients with mild to moderate obstructive sleep apnea (OSA). Sleep Breath. 2018;22:323\u20138.","journal-title":"Sleep Breath"},{"key":"1252_CR23","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1053\/apmr.2002.30937","volume":"82","author":"TG Wang","year":"2002","unstructured":"Wang TG, Wang YH, Tang FT, Lin KH, Lien IN. Resistive inspiratory muscle training in sleep disordered breathing of traumatic tetraplegia. Arch Phys Med Rehab. 2002;82:491\u20136.","journal-title":"Arch Phys Med Rehab"},{"key":"1252_CR24","doi-asserted-by":"publisher","DOI":"10.1038\/scsandc.2015.10","volume":"1","author":"CL Boswell-Ruys","year":"2015","unstructured":"Boswell-Ruys CL, Lewis RHC, Gandevia SC, Butler JE. Respiratory muscle training may improve respiratory function and obstructive sleep apnoea in people with cervical spinal cord injury. Spinal Cord Ser Cases. 2015;1:15010.","journal-title":"Spinal Cord Ser Cases"},{"key":"1252_CR25","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1136\/thoraxjnl-2019-213917","volume":"75","author":"CL Boswell-Ruys","year":"2020","unstructured":"Boswell-Ruys CL, Lewis RHC, Wijesuriya NS, McBain RA, Lee BB, McKenzie DK, et al. Impact of respiratory muscle training on respiratory muscle strength, respiratory function and quality of life in individuals with tetraplegia: a randomised clinical trial. Thorax. 2020;75:279\u201388.","journal-title":"Thorax"},{"key":"1252_CR26","unstructured":"Berry, RB, Albertario, CL, Harding, SM, Lloyd, RM, Plante, DT, Quan, SF, et al. (2018). The AASM manual for the scoring of sleep and associated events: Rules, terminology and technical specifications (Version 2.5). American Academy of Sleep Medicine; Darien, Illinois."},{"key":"1252_CR27","doi-asserted-by":"publisher","DOI":"10.14814\/phy2.15930","volume":"12","author":"A Sankari","year":"2024","unstructured":"Sankari A, Najjar AA, Maresh SA, Prowting JL, Fung CH, Knack A, et al. Feasibility of oropharyngeal and respiratory muscle training in individuals with OSA and spinal cord injury or disease: a pilot study. Physiological Rep. 2024;12:e15930.","journal-title":"Physiological Rep"},{"key":"1252_CR28","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1164\/rccm.202107-1761OC","volume":"205","author":"B Lechat","year":"2022","unstructured":"Lechat B, Naik G, Reynolds A, Aishah A, Scott H, Loffler KA, et al. Multinight prevalence, variability, and diagnostic misclassification of obstructive sleep apnea. Am J Respir Crit Care Med. 2022;205:563\u201369.","journal-title":"Am J Respir Crit Care Med"},{"key":"1252_CR29","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.chest.2023.01.027","volume":"164","author":"B Lechat","year":"2023","unstructured":"Lechat B, Nguyen DP, Reynolds A, Loffler K, Escourrou P, McEvoy RD, et al. Single-night diagnosis of sleep apnea contributes to inconsistent cardiovascular outcome findings. Chest. 2023;164:231\u201340.","journal-title":"Chest"},{"key":"1252_CR30","doi-asserted-by":"publisher","first-page":"65","DOI":"10.5664\/jcsm.3362","volume":"10","author":"A Sankari","year":"2014","unstructured":"Sankari A, Bascom A, Oomman S, Badr MS. Sleep disordered breathing in chronic spinal cord injury. J Clin Sleep Med. 2014;10:65\u201372.","journal-title":"J Clin Sleep Med"},{"key":"1252_CR31","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1113\/jphysiol.2012.245159","volume":"591","author":"LH White","year":"2013","unstructured":"White LH, Bradley TD. Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea. J Physiol. 2013;591:1179\u201393.","journal-title":"J Physiol"},{"key":"1252_CR32","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1038\/s41393-019-0256-6","volume":"57","author":"NS Wijesuriya","year":"2019","unstructured":"Wijesuriya NS, Eckert DJ, Jordan AS, Schembri R, Lewis RHC, Meaklim H, et al. A randomised controlled trial of nasal decongestant to treat obstructive sleep apnoea in people with cervical spinal cord injury. Spinal Cord. 2019;57:579\u201385.","journal-title":"Spinal Cord"},{"key":"1252_CR33","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1093\/sleep\/28.4.457","volume":"28","author":"JP Kirkness","year":"2005","unstructured":"Kirkness JP, Madronio M, Stavrinou R, Wheatley JR, Amis TC. Surface tension of upper airway mucosal lining liquid in obstructive sleep apnea\/hypopnea syndrome. Sleep. 2005;28:457\u201363.","journal-title":"Sleep"},{"key":"1252_CR34","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1113\/jphysiol.2005.102129","volume":"574","author":"M Verma","year":"2006","unstructured":"Verma M, Seto-Poon M, Wheatley JR, Amis TC, Kirkness JP. Influence of breathing route on upper airway lining liquid surface tension in humans. J Physiol. 2006;574:859\u201366.","journal-title":"J Physiol"},{"key":"1252_CR35","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1136\/bmj.38705.470590.55","volume":"332","author":"MA Puhan","year":"2006","unstructured":"Puhan MA, Suarez A, Lo Cascio C, Zahn A, Heitz M, Braendli O. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006;332:266\u201370.","journal-title":"BMJ"},{"key":"1252_CR36","doi-asserted-by":"publisher","first-page":"97","DOI":"10.4236\/ijohns.2013.23023","volume":"2","author":"MP Hilton","year":"2013","unstructured":"Hilton MP, Savage JO, Hunter B, McDonald S, Repanos C, Powell R. Singing exercises improve sleepiness and frequency of snoring among snorers: a randomised controlled trial. Int J Otolaryngology Head Neck Surg. 2013;2:97\u2013102.","journal-title":"Int J Otolaryngology Head Neck Surg"},{"key":"1252_CR37","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1164\/rccm.200806-981OC","volume":"179","author":"KC Guimaraes","year":"2009","unstructured":"Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009;179:962\u20136.","journal-title":"Am J Respir Crit Care Med"}],"container-title":["Spinal Cord"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41393-026-01252-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41393-026-01252-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41393-026-01252-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T01:05:29Z","timestamp":1793754329000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41393-026-01252-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":37,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["1252"],"URL":"https:\/\/doi.org\/10.1038\/s41393-026-01252-8","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7522267\/v1","asserted-by":"object"}]},"ISSN":["1362-4393","1476-5624"],"issn-type":[{"value":"1362-4393","type":"print"},{"value":"1476-5624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"2 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Outside the current work, DJE reports grants from Bayer, Apnimed, Eli Lilly, Restera (formally Invicta Medical), Restora, Withings and Takeda and serves on Scientific Advisory Boards or as a consultant for Restera, Mosanna, Restora, ResSleep, Takeda and Apnimed. The other authors have no conflicts of interest to report.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}}]}}